Consent Form Language Translation

With a relatively high population of patients in this region who are English language learners, or otherwise not fluent in English, the unavailability of translated patient consent forms could be problematic.  The first language of many patients in Central Oregon is Spanish, however, the site has not yet received consent forms in any language other than English. 

In attempt to circumvent this issue, the Mosaic Medical language specialist has translated a portion of the necessary forms, and the translated draft is currently under review by Mosaic’s document review committee.  The specialist, however, is not in a position to translate all necessary documents in their entirety for the following reasons:

·      Ethical question of placing responsibility on medical interpreters to translate legal documents, as they may not be properly trained in this language

·      Difficulty of translating a technical English document, maintaining sensitivity to reading levels and nuances of language

Thus far, only one patient has been unable to independently read and sign the consent form due to it’s being unavailable in Spanish.  In this case, a translator was unavailable to accompany the RN and TCA to the installation.  The necessitation of a translator during home installations can pose a burden for the clinic, and may slow the process of delivering remote care to patients.

Possible resolutions of the consent form translation predicament will be discussed during the next meeting of COTN and RCCHC.

Patient Referral

During a recent installation, a patient inquired as to whether their spouse could use the blood pressure cuff newly installed in their home to monitor his own blood pressure.

Although the answer was no, this is one example of a positive referral being made by a program participant due to their own involvement with and enthusiasm regarding the possibilities of remote monitoring.  It has not yet been determined whether this patient's spouse will be recommended for the program by their PCP, but this demonstrates the value that some patients place on being able to monitor their health independently.

Transmission Difficulties

The new equipment that has replaced older PODs has been a step forward in remote patient monitoring in the region.  However, equipment challenges persist.  The most recent encounter involved an installation in a home with a roof made of metal.  It seemed that the metal roofing of the home, which extended into the eaves, caused difficulties with the PODs ability to relay a signal.  Some patience combined with patient flexibility aided in testing the POD in different locations around the home, resulting, eventually, in a successful transmission.  This issue could be potentially troublesome due to the unanticipated amount of extra time that the installation took.       

Patient Investment in Remote Monitoring

Despite a consolidated team-wide effort, maintaining patient buy-in throughout their planned course of involvement in the program continues to be of concern. 

To ensure that patients are well informed regarding the benefits and potential challenges of daily monitoring from home, primary care providers explain the process to patients in office, when the initial recommendation is made.  During installation, the RNCC and Team Care Assistant follow-up on this information, targeting other potential challenges that may arise during the home visit, and repeating the reasons for referral. 

Although there has been much success in the program thus far, patients occasionally agree to participate in the program only to request equipment removal in a short amount of time – as little as two days, in some cases.  There are a few possible explanations that we have seen thus far.  Patients may simply agree to participate when it is recommended by their PCP in the office, viewing their PCP as an authority to whom they should comply, but re-thinking it when the reality of the program sets in.  Even with authentic buy-in initially, the demand of maintaining a consistent schedule and taking readings when necessary could pose too troublesome of a challenge.  Patients also may not be emotionally prepared to see their own readings each day, triggering anxiety and feelings of hopelessness when faced by the experience of daily weight or blood sugar checks, for example. 

Each case presents a different outcome, sometimes resulting in the early removal of a specific instrument or all equipment from the patient’s home, and other times with the patient retaining the equipment but refraining from using it regularly.  In the latter circumstance, keeping the instrument nearby may be a practical solution.  In the case that a PCP may unexpectedly require a specific reading, a simple phone call may be made to request that the patient comply at that time, even though readings are not taken daily.  Such a compromise may be a logical way for the program to continue to assist in the monitoring of patients who are not fully invested.